MANAGING DBS PROBLEMS & FAILURES AFTER DEEP BRAIN STIMULATION SURGERY
Sierra Farris, MA, MPAS, PA-C
Deep brain stimulation (DBS) is a surgical treatment for movement problems associated with Parkinson’s disease, tremor or dystonia. DBS is very effective in controlling many symptoms related to abnormal movement; however dissatisfaction with the therapy can occur at any time after surgery. Expectations for DBS are generally high as is the risks of having brain surgery. Expectations beyond what the therapy can provide are a high source of patient and family dissatisfaction. Adequate pre-surgical counseling is a key step in assuring you and your patient are in agreement about the expected benefit and risks associated with DBS.
When and where to pursue DBS Troubleshooting
Common causes of DBS failures, problems or dissatisfaction:
- Inadequate or inappropriate adjustment to stimulation
- Disease progression
- Damaged DBS hardware or depleted battery
- Inadequate placement of the implanted electrodes
- Inadequate medications or expectations
- Inappropriate diagnosis
- DBS done too late to achieve optimal benefit
Our DBS Troubleshooting Clinic is a unique multi-day clinic for individuals with DBS seeking a second opinion about programming, determining adequate medication dosing and/or to investigate problems from stimulation or the hardware. Multiple visits with our team may be required to complete the assessment. All visits are tailored to each individual to investigate the cause(s) of dissatisfaction or ineffectiveness of DBS.
We summarized the results from 50 people seen for troubleshooting below.
Problems ranged (in order of prevalence) from walking/balance, Off time, falls, speech, tremor dyskinesia and no improvement were the most common reasons for troubleshooting. These symptoms are commonly associated with disease progression and may not be investigated after DBS. We have learned from our troubleshooting experience that many symptoms that worsen after DBS can still be improved with careful and meticulous evaluation of the variables that can lead to worsening symptoms. Dr. Monique Giroux and Sierra Farris work together to find solutions to the many problems that can occur months to years after DBS surgery. Some patients will see a physical therapist or speech therapist to help fine tune the stimulation settings for optimal benefit.
Symptoms commonly associated with disease progression can be improved with therapeutic stimulation settings such as speech, walking, stiffness, slowness tremor and balance. Some people did not experience an improvement in symptoms including gait freezing, falls and balance, however, what is obvious in our results is sub-optimal stimulation settings can definitely worsen a person’s symptoms. Some of the patients in this series had DBS for over 5 years but were still improved with reprogramming. We feel that patients should have a thorough evaluation for worsening symptoms no matter how long they have had DBS.
We also believe patients should have confidence that the DBS is working as well as possible to be free of the concerns and stress that can accompany uncertainty. We include an evaluation and discussion about what should be expected from DBS and review the steps if DBS is not performing as expected. Our troubleshooting evaluation includes a medical consultation and structured DBS programming strategies to optimize benefit while avoiding or eliminating stimulation side effects. Surgical consultation is coordinated if indicated.
Read about three incredible individuals living with Parkinson’s disease that were seen in our troubleshooting clinic. Each was determined to find solutions for their unsuccessful DBS surgery and disability from stimulation side effects. You will read about amazing recoveries after proper programming and a new lease on life after revision surgery. Meet Charlene. Meet Dean. Meet Bill.
A pre-appointment consultation is available to patients who would like to discuss their concerns prior to setting up appointments for DBS troubleshooting. Call Celina Romero at 303-781-0511 for special instructions. We require brain imaging and surgical reports prior to scheduling to make sure we optimize Sierra’s time with you during the appointments. Average length of evaluation is 3 days. We have served many patients that live out of state. Learn more about our Comprehensive DBS Services or Sierra Farris, PA-C.